Objective ·To investigate the changes in transcriptome and chromatin accessibility during the differentiation of human embryonic stem cells (hESCs) into neural progenitor cells (NPCs) using in vitro differentiation models and high-throughput multi-omics sequencing technologies. Methods ·hESCs were first induced to differentiate into NPCs in vitro using the embryoid body formation method, and cells at both stages were collected. The cell phenotypes were identified by reverse transcription-quantitative real-time PCR (RT-qPCR) and immunofluorescence (IF) staining. Transcriptome sequencing (RNA-seq) was conducted to detect and analyze the differentially expressed genes (DEGs) between hESCs and NPCs. The assay for transposase-accessible chromatin with high-throughput sequencing (ATAC-seq) was employed to assess chromatin accessibility changes between hESCs and NPCs. Motif enrichment analysis was performed on differentially accessible chromatin regions to discover potential regulatory transcription factors. Finally, an integrated analysis of RNA-seq and ATAC-seq data and the protein-protein interaction (PPI) network were performed to identify key genes and regulatory pathways involved in the early stages of neural differentiation in vitro. Results ·Both RT-qPCR and IF results indicated that the expression levels of pluripotency markers (NANOG and POU5F1) were high at the hESC stage but significantly decreased at the NPC stage, while early neural differentiation markers (PAX6, SOX1, and NES) were minimally expressed at the hESC stage but markedly upregulated at the NPC stage. RNA-seq analysis revealed that compared to the hESC stage, there were 5 597 genes upregulated and 3 654 genes downregulated at the NPC stage. Gene function enrichment analysis showed that the upregulated genes at the NPC stage were enriched in the functions related to neural development. ATAC-seq analysis demonstrated a total of 27 491 genomic regions had significant changes in chromatin accessibility during the differentiation from hESC to NPC, with 12 381 regions showing increased accessibility and 15 110 regions showing decreased accessibility. Motif enrichment analysis revealed that transcription factor genes such as DLX1 and LHX2 might play an important role in the differentiation process from hESCs into NPCs. Integrated analysis of RNA-seq and ATAC-seq data revealed that overlapping genes with high expression at the NPC stage were mainly enriched in axon guidance, forebrain development, and neuron migration. After neural differentiation, the expression levels of CTNND2 and LHX2 genes increased, and the chromatin accessibility of related genomic regions also increased. PPI network analysis indentified candidate downstream genes including PRKACA, CDH2, and ERBB4. Conclusion ·The in vitro differentiation model of hESCs combined with high-throughput multi-omics sequencing technologies can be used to depict the changes in transcriptome and chromatin accessibility during the differentiation of hESCs into NPCs. In this process, the expression levels of genes related to axon guidance, forebrain development, and neuronal migration pathways increase and related chromatin accessibility is enhanced.

Objective ·To detect the expression level of Fas-associated protein with death domain (FADD) in head and neck squamous cell carcinoma (HNSCC) and to explore the molecular mechanisms by which FADD promotes the proliferation of HNSCC cells. Methods ·The GEPIA 2 database was utilized to analyze the expression level of FADD in tumor tissues and to evaluate its association with prognosis. Immunohistochemistry staining (IHC) was performed on HNSCC tissues to investigate the changes in FADDexpression levels in normal, dysplastic, and tumor tissues. Stable FADD-knockdown Fadu and HSC3 cell lines were constructed and validated using Western blotting and quantitative real-time PCR (qRT-PCR). The regulatory effect of FADD on the proliferation of HNSCC cells was explored using the LiveCyte live-cell tracking system, colony formation assay, and cell viability assay. Proteins interacting with FADD were identified by co-immunoprecipitation mass spectrometry (Co-IP/MS), and further mechanistic studies were conducted using CRISPR/Cas9 technology, LiveCyte live-cell tracking system, and Western blotting. Results ·Analysis of the GEPIA2 database indicated that FADD was significantly overexpressed in head and neck cancer and was associated with poor prognosis. IHC staining showed that FADD expression levels progressively increased from normal to dysplastic to tumor tissues in HNSCC patients. Knockdown of FADD in HNSCC cells resulted in significantly reduced proliferation and colony formation compared to the control group. Co-IP/MS results showed that FADD interacted with the CUX1 protein, and FADD knockdown led to increased CUX1 expression. Moreover, CUX1 knockdown significantly promoted HNSCC cell proliferation and reversed the anti-proliferative phenotype caused by FADD knockdown. Conclusion ·FADD plays a significant pro-carcinogenic role in HNSCC and is associated with poor prognosis. FADD can further regulate tumor cell proliferation by interacting with CUX1 and suppressing its expression level.

Objective ·To investigate the effects of liraglutide on liver fibrosis in mice with non-alcoholic fatty liver disease (NAFLD) and the underlying mechanisms. Methods ·Twenty 8-week-old C57BL/6J mice were randomly divided into a normal chow diet group (Chow group) and a methionine-choline-deficient (MCD) diet group (MCD group), with 10 mice per group. The MCD diet was used to induce NAFLD. Each group was further divided into two subgroups, resulting in four subgroups: Chow+saline, Chow+liraglutide, MCD+saline, and MCD+liraglutide group. After daily intraperitoneal injection of liraglutide (400 μg/kg) or an equivalent volume of saline for 4 weeks, an intraperitoneal glucose tolerance test (IPGTT) was performed. Serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), total cholesterol (TC), triglyceride (TAG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured. Liver tissues were collected post-euthanasia to assess TAG content. Histopathological changes, lipid deposition, and fibrosis were evaluated via hematoxylin-eosin (HE) staining, Oil Red O staining, and Masson staining. Real-time quantitative PCR (qPCR) and Western blotting were used to analyze the expression of α-smooth muscle actin (α-SMA), fibronectin (FN), collagen type Ⅰ α (COL1A), matrix metalloproteinase 9 (MMP9), tissue inhibitor of metalloproteinase 1 (TIMP1), transforming growth factor β (TGF-β), SMAD3, and phosphorylated SMAD3 (pSMAD3). Results ·The IPGTT revealed that liraglutide intervention reduced blood glucose levels at 15, 30, and 60 min, with a decreased area under the curve (AUC) (both P<0.05). Biochemical analysis showed that liraglutide lowered AST and ALT levels (both P<0.001), increased TC and HDL-C levels (both P<0.05), but had no significant effect on TAG or LDL-C in MCD mice. HE staining and Oil Red O staining revealed reduced lipid droplets, ballooning degeneration, and inflammatory infiltration in hepatocytes after liraglutide treatment. Masson staining indicated decreased collagen fiber deposition in the liver. qPCR and Western blotting analysis demonstrated upregulated expression of α-SMA, FN, COL1A, TIMP1, TGF-β, and pSMAD3/SMAD3, alongside downregulated MMP9 in MCD mice. Liraglutide reversed these changes, lowering α-SMA, FN, COL1A, TIMP1, TGF-β, and pSMAD3/SMAD3 expression while increasing MMP9 expression. Conclusion ·Liraglutide ameliorates liver injury, lipid deposition, and fibrosis in NAFLD mice, through modulation of the TGF-β/SMAD3 pathway and regulating fibrosis-associated protein expression.

Objective ·To Investigate the effects of salidroside (SAL) on the immune response of macrophages infected with BCG. Methods ·RAW264.7 mouse macrophages were infected with BCG, and the experiments were divided into blank control (BCG), salidroside (SAL+BCG), isoniazid (INH+BCG), and salidroside+isoniazid (SAL+INH+BCG) groups. The effects of SAL and INH on the proliferation of RAW264.7 cells were detected by MTT colorimetric assay, and the experimental concentrations of SAL and INH were screened. After the establishment of the BCG-infected macrophage model, intracellular bacterial survival was detected by bacterial plate count and flow cytometry following salidroside pretreatment. The levels of tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-6 (IL-6) , and interleukin-10 (IL-10) in the culture supernatants were measured by enzyme-linked immunosorbent assay, and apoptosis levels were assessed by flow cytometry. Results ·SAL at a concentration of 800 μmol/L and INH at 10 μmol/L were selected for subsequent experiments. Compared with the BCG group, SAL pretreatment for 36 h had the best effect, and the growth of BCG in macrophages in the administered group was inhibited. The inhibitory effect of the combined application of SAL and INH was obvious and statistically significant. Compared with the BCG group, SAL alone led to decreased secretion of TNF-α, IFN-γ, IL-6, and IL-10, although the differences were not statistically significant. However, the combination of SAL and INH caused a significant decrease in the levels of TNF-α, IL-6 and IL-10 in the supernatants of the cells (all P<0.05). Compared with the BCG group, in the early stage of the infection, SAL and INH were able to significantly reduce the apoptotic levels of BCG-infected RAW264.7 cells (P=0.008, P=0.032), and the combined application of SAL and INH significantly enhanced the apoptosis levels of BCG-infected RAW264.7 cells in the late stage of infection (P=0.001). Conclusion ·In BCG-infected macrophages, SAL can exhibit antimycobacterial effects on the host by enhancing macrophage immune function, suppressing intracellular bacterial survival, and concurrently mitigating the inflammatory response elicited by BCG infection.

Objective ·To investigate the longitudinal changes in amygdala and hippocampal subfield volumes before and after transcranial magnetic stimulation (TMS) treatment in patients with major depressive disorder (MDD) and explore their correlation with the antidepressant and anxiolytic efficacy of TMS. Methods ·A total of 58 patients diagnosed with MDD at Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, were included in this study between January 2018 and August 2023. Clinical depressive and anxiety symptoms were assessed by using the Hamilton Depression Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS), and Hamilton Anxiety Scale (HAMA) at baseline and post-TMS treatment. Patients underwent a baseline magnetic resonance imaging (MRI) scan followed by TMS treatment targeting the left dorsolateral prefrontal cortex (DLPFC) at a frequency of 10 Hz, totaling 20 sessions. A follow-up MRI scan was conducted on the same day the TMS treatment concluded. Amygdala and hippocampal subfield volumes were segmented and calculated by using FreeSurfer v6.0.0 software. Longitudinal changes in the subfield volumes were analyzed with two-way analysis of variance. Controlling for age, sex, and intracranial volume, partial correlation analysis was conducted between subfield volumes and baseline clinical scores. The association between the rate of volume change in brain regions with significant volume changes and symptom improvement (reduction in HAMD, MADRS, and HAMA scores) was evaluated. Results ·Following TMS treatment, a significant increase in the volume of the right amygdala central nucleus was observed (t=-2.441, P=0.018). While the volumes of bilateral hippocampal fimbria decreased, the volumes of most hippocampal subfield and the total hippocampus increased (P<0.05). No significant correlations were found between baseline amygdala or hippocampal subfield volumes and clinical depressive and anxiety symptoms. However, only in patients who responded effectively to TMS treatment, a positive correlation was found between the volume change rate of the left hippocampal tail and reductions in anxiety symptoms (HAMA: r=0.334, P=0.044). Conclusion ·High-frequency TMS targeting the left DLPFC may induce volume increases in the right amygdala central nucleus and specific hippocampal subfields. Additionally, the volume change rate of the left hippocampal tail is associated with anti-anxiety effects in TMS responders, suggesting that high-frequency TMS targeting the left DLPFC may induce neuroplastic changes in the central nucleus of the right amygdala and key subfields of the hippocampus.

Objective ·To monitor postoperative blood glucose (BG) and blood lipids (BL) at multiple time points in pediatric patients undergoing liver transplantation (LT) and to analyze the influencing factors. Methods ·An observational study was conducted, including pediatric LT patients from the Hepatic Surgery Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine. Blood samples were collected one day before surgery and on days 1, 7, and 14 after surgery. Basic patient information and laboratory indicators were recorded, including complete blood count (CBC), cytochrome P450 (CYP) genotyping, tacrolimus dosage (TD), tacrolimus serum drug level (TSDL), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), and biochemical testing for liver transplantation (BTLT). BTLT included the following indicators: total protein (TP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), transglutaminase (GGT), direct bilirubin (DBil), total bilirubin (TBil), creatinine (Cr), triglyceride (TAG), total cholesterol (TC), prothrombin time (PT), and international normalized ratio (INR). The t-test or Mann-Whitney U test was used to analyze factors influencing PBG, Cox regression analysis was used to analyze factors influencing FBG, and logistic regression analysis was used to analyze factors influencing TC. Results ·A total of 82 pediatric LT patients were included, with 45 males (54.9%) and 37 females (45.1%). The average age was 7 months, average height was 65 cm, and average body weight was 7.15 kg. FBG [(6.54±1.71) mmol/L] and PBG [(7.42±2.19) mmol/L] reached their highest values on the first postoperative day and gradually decreased to normal levels. There were 59 patients in the normal FBG and PBG groups and 23 in the abnormal groups. TAG [(0.93±0.63) mmol/L] and TC [(1.91±1.08) mmol/L] reached their lowest values on the first postoperative day and then slowly increased. The t-test indicated that TP (P=0.050), AKP (P=0.020), GGT (P=0.002), TC (P=0.017), and TD (P=0.028) showed statistically significant differences between the normal and abnormal PBG groups. Cox regression analysis showed that gender (HR=0.501, 95% CI 0.184‒1.361), age (HR=0.972, 95% CI 0.876‒1.079), height (HR=1.012, 95% CI 0.903‒1.135), body weight (HR=1.067, 95% CI 0.720‒1.579), and blood type (A type HR=1.294, 95% CI 0.464‒3.612; B type HR=1.303, 95% CI 0.456‒3.723; AB type HR=1.520, 95% CI 0.310‒7.441) did not significantly affect the BG's time change process. Logistic regression analysis showed that the patient's CYP (1×3 OR=9.332, 95% CI 0.960‒90.719; 3×3 OR=18.083, 95% CI 1.414‒231.219) was a factor influencing TC. Conclusion ·TD is a factor influencing PBG on the first postoperative day, and the patient's CYP is a factor influencing TC on the same day.

Objective ·To investigate the predictive value of the geriatric nutritional risk index (GNRI) for the occurrence of lung infection in hospitalized elderly patients with type 2 diabetes mellitus (T2DM). Methods ·Elderly T2DM patients who were admitted to the Geriatric Department of Shanghai Tongren Hospital between June 2022 and June 2024 were retrospectively and consecutively enrolled. They were divided into infected and non-infected groups according to whether lung infection occurred during hospitalization. Baseline data (gender, age, height, weight, duration of diabetes, comorbidities, etc.) were collected and GNRI was calculated. A multivariate Logistic regression model was used to screen the independent risk factors for pulmonary infections,and the predictive value of GNRI for pulmonary infections in T2DM patients was analysed using receiver operating characteristic (ROC) curves. Results ·A total of 264 elderly T2DM patients were enrolled, among whom 154 developed pulmonary infections. Significant differences were observed between the infected and non-infected groups in GNRI, albumin, leukocyte count, neutrophil ratio, lymphocyte ratio, glycated hemoglobin, fasting glucose, interleukin-6, C-reactive protein, and procalcitonin levels (P<0.05). Multivariate Logistic regression analysis showed that a lower GNRI was an independent risk factor for lung infection (OR=0.798, 95%CI 0.712‒0.894; P<0.001). Correlation analysis showed that GNRI was negatively correlated with C-reactive protein and calcitoninogen. ROC curve analysis showed that GNRI predicted pulmonary infection with an area under the curve of 0.828, a sensitivity of 77.9%, and a specificity of 76.6%. Conclusion ·A lower GNRI is an independent risk factor for pulmonary infections in elderly T2DM patients, and also has a good predictive value for the occurrence of pulmonary infections.

Objective ·To evaluate the predictive value of anti-neutrophil cytoplasmic antibodies (ANCA) in Kawasaki disease (KD) complicated with coronary artery lesions (CALs) and to construct a nomogram prediction model. Methods ·A retrospective study was conducted to collect the clinical data of 340 children with KD admitted to Shanghai Children's Medical Center from January 2018 to May 2024. All patients were randomly divided in a 7:3 ratio into a training set (n=237) and a validation set (n=103). Univariate analysis and least absolute shrinkage and selection operator (LASSO) were applied to screen the risk factors of CALs, which were incorporated into multifactorial Logistic regression analysis to develop the nomogram model. The model's discrimination, calibration and clinical practicability were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA). A new predictive scoring system was obtained by assigning scores to each variable based on the coefficients of the independent variables in the Logistic regression equation, and its predictive efficacy was then compared with that of three commonly used scoring systems, Kobayashi, Egami, and Sano scoring models. Results ·Male, low serum albumin level, ANCA positivity, and intravenous immunoglobulin resistance were risk factors for the development of CALs in children with KD, based on which a nomogram model was constructed. The area under the ROC curve for the nomogram in the training set and validation set were 0.747 (95%CI 0.667‒0.821) and 0.645 (95%CI 0.500‒0.794), respectively, indicating good effectiveness. The model was verified to have good predictive accuracy through the calibration curve and Hosmer-Lemeshow goodness-of-fit test (training set: χ² =5.105, P=0.746; validation set:χ² =13.549, P=0.094). The DCA showed its clinical usefulness. A predictive scoring system for CALs was developed based on the coefficients of the Logistic regression equation, which demonstrated higher sensitivity (58.4%) and specificity (78.7%) compared to the Kobayashi, Egami, and Sano scoring models. Conclusion ·This study developed a new scoring model based on ANCA to effectively predict the risk of CALs in KD patients. The model provides valuable reference for clinicians to identify high-risk patients early, and to formulate personalized treatment plans and management strategies.

Objective ·To elucidate the causal relationship between obstructive sleep apnea (OSA) and imaging-derived phenotypes (IDPs) through two-sample Mendelian randomization (MR) studies. Methods ·The genetic data related to OSA were obtained from the genome-wide association study (GWAS) (n_{case group}=50 200, n_{control group}=401 484) in the FinnGen Biobank R11. Twenty-seven single nucleotide polymorphisms (SNPs) were screened out as instrumental variables of OSA. The GWAS of 3 935 IDPs was based on multimodal neuroimaging data from 39 691 individuals of European ancestry in the UK Biobank. Multiple MR methods, primarily utilizing inverse variance weighted (IVW) analysis, were applied, along with assessments for heterogeneity, pleiotropy, and sensitivity. Results ·MR analysis indicated that 8 IDPs were associated with OSA. For example, the genetically determined volume of caudal middle frontal gyrus in the right hemisphere was associated with an increased risk of OSA. A one‒standard-deviation increase in volume corresponded to an 11% higher risk of OSA (IVW OR=1.11, 95%CI 1.06‒1.17, P<0.001). Genetically determined reduced risk of OSA was associated with a resting-state functional connectivity characteristic (IVW β=-0.10, 95%CI -0.19‒-0.01, P=0.025), representing the functional connectivity strength between the bilateral frontal poles and the right frontal-parietal cortex. The heterogeneity test did not find significant heterogeneity among the instrumental variables. The pleiotropy test did not detect any pleiotropy. The sensitivity analysis indicated stable results. Conclusion ·Eight IDPs may have a causal relationship with the occurrence of OSA, among which one IDP shows a bidirectional causal relationship, providing potential targets for non-invasive neuromodulation interventions in OSA.

Objective ·To comprehensively evaluate the efficiency of different kits and methods for DNA and RNA extraction from blood samples. Methods ·A total of 145 blood samples were collected, including those from patients with Alzheimer's disease (20 cases), fibrosis (5 cases), colorectal cancer (108 cases), and healthy individuals (12 cases). A column-based kit (Kit A) and a nucleic acid extraction instrument were used to extract genomic DNA (gDNA) from leukocytes in the blood. Cell-free DNA (cfDNA) and cell-free RNA (cfRNA) in plasma were extracted using five different kits (Kit B‒F), which employed either column-based (Kit B, E) or magnetic bead-based methods (Kit C, D, F). The extraction process of Kit B was optimized by increasing the plasma sample volume and extending the elution incubation time. Furthermore, this protocol was applied to extracting cfDNA from plasma samples of 100 colorectal cancer patients. Quantitative real-time PCR (qPCR) was used to quantify the extracted DNA and RNA, and the molecular yields were compared to evaluate the extraction efficiency. A comprehensive assessment was conducted, considering factors such as cost and operation time. Results ·In gDNA extraction, although the the operation time was shortened by using the nucleic acid extraction instrument, the median number of DNA molecules extracted using Kit A (column-based method) was 25.36-fold higher than that obtained with the instrument (P<0.05). For cfDNA extraction, while the overall efficiency of the three kits (Kit B‒D) was similar, Kit B (column-based method) showed superior performance in low-concentration samples, with average DNA yields 4.24-fold and 1.18-fold higher than those of Kit D and Kit C (both magnetic bead-based). Optimization of Kit B's extraction protocol further improved cfDNA yield. When comparing three samples, the cfDNA yields from larger plasma input volumes was 3.98-fold, 2.38-fold, and 3.82-fold higher than those from smaller input volumes, respectively. The results of cfDNA extraction from 100 colorectal cancer patients indicated that this extraction protocol reliably extracted sufficient amounts of cfDNA from clinical samples. For cfRNA extraction, Kit E (column-based method) was widely recommended due to its high efficiency, convenience, and cost-effectiveness. The median RNA content extracted using Kit E was 5.01-fold higher than that of Kit F (magnetic bead-based method). Lastly, a comparison of the copy numbers of cfDNA and cfRNA in plasma revealed that the average copy number of cfRNA per milliliter of plasma was 27.65-fold higher than that of cfDNA. Conclusion ·Kit A, Kit B, and Kit E show outstanding performance in leukocyte gDNA extraction, plasma cfDNA extraction, and plasma cfRNA extraction, respectively. However, although Kit E has advantages in extraction efficiency and cost, its safety requires further evaluation.

Reactive oxygen species (ROS) are common products of bone tissue injury. If ROS cannot be removed in time, oxidative stress will be induced in the cells, which will have a negative effect on the regeneration of bone tissue. In recent years, with the deepening of research, nanomaterials capable of reducing ROS levels have shown increasing potential in promoting bone tissue regeneration. Currently, nanomaterials applied to reduce ROS levels mainly include those with surface modifications and microstructural designs, dopant-modified inorganic materials, functionalized polymeric materials and hydrogels, and nano-enzymatic materials. However, the clinical application of these nanomaterials is still limited due to their potential cytotoxicity and the lack of sufficient clinical trials. This literature review summarises the research on the use of nanomaterials to reduce ROS levels to promote bone regeneration and provides ideas for the future design and development of novel nanomaterials in this field.

In patients with heart failure with reduced ejection fraction (HFrEF), some individuals demonstrate significant improvement in left ventricular ejection fraction (LVEF) during subsequent evaluations after treatment. The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) heart failure management guidelines introduced the term "heart failure with improved ejection fraction (HFimpEF)" to describe patients with prior LVEF≤40% that subsequently increased above 40% during follow-up. Studies indicate that HFimpEF patients exhibit lower all-cause mortalities and heart failure rehospitalization rates, with a significantly better prognosis compared to HFrEF patients, establishing HFimpEF as a staged therapeutic target for HFrEF. Current discussion on HFimpEF primarily focuses on two aspects: characteristics of the target population and effective methods for LVEF improvement, and maintenance strategies for cardiac function preservation in HFimpEF patients; particularly the latter lacks clear clinical-guideline recommendations. Therefore, reviewing existing research to systematically summarize therapeutic strategies that promote the HFrEF-to-HFimpEF transition and effective maintenance approaches for HFimpEF becomes crucial. This article comprehensively reviews the LVEF-improving effects of current pharmacological, device-based, and surgical interventions, along with monitoring and management strategies for HFimpEF patients. In HFrEF patients, clinical evidence suggests that β-blockers and cardiac resynchronization therapy can significantly improve LVEF beyond 40%. Regarding HFimpEF management, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and renin-angiotensin system inhibitors (RASi) demonstrate efficacy in maintaining LVEF and cardiac function. Additionally, this review identifies current research limitations in HFimpEF and proposes potential future research directions.

Lead is a ubiquitous toxic heavy metal and one of the earliest and most widely used heavy metal elements in human history. Due to its non-degradable nature in the environment and its long biological accumulation effects (lasting up to 30‒50 years) in the human body, even trace amounts of lead can cause significant health damage. It has therefore been classified as one of the top ten public health concerns by the World Health Organization (WHO). Once absorbed into the body, lead is typically distributed in tissues such as the brain, liver, kidneys, teeth, and bones, thereby exerting widespread toxic effects on multiple organ systems. Epigenetics is the study of heritable changes in gene expression that occur without alterations in the nucleotide sequence. It reveals how modifications in gene expression regulate cellular functions, leading to diverse cellular phenotypes and functions despite identical DNA sequences. Although the toxic mechanisms of lead are not yet fully elucidated, recent studies suggest that epigenetic regulation may play a significant role in mediating lead toxicity. Environmental lead exposure can induce various epigenetic modifications in cells, such as DNA methylation, histone modifications, and microRNA (miRNA) alterations, which, in turn, can trigger multiple toxic responses. This paper presents a concise overview of current epigenetic investigations into lead toxicity, emphasizing DNA methylation, histone modifications, and miRNA dynamics. By adopting an epigenetic perspective, it offers a theoretical framework into understanding lead's toxic mechanisms comprehensively, facilitating further research in prevention and treatment strategies.

Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia resulting from increased platelet destruction and impaired platelet production. Although the majority of patients have a relatively good prognosis, 10%‒20% of children and up to 75% of adults may progress to chronic primary immune thrombocytopenia (CITP). These patients exhibit poor response to multiple therapies, leading to a significant decline in quality of life. At present, the treatment strategies for CITP mainly include first-line therapies such as glucocorticoids and gamma globulin, and second-line therapies such as thrombopoietin receptor agonists (TPO-RAs), rituximab, immunosuppressants, and splenectomy. In recent years, with the in-depth research on CITP, some new biological drugs and immunotherapies, such as Fcγ receptor (FcγR) signal transduction inhibitors, neonatal Fc receptor inhibitors, complement inhibitors, immune-cell-targeted therapies, platelet desialylation, umbilical cord mesenchymal stem cell therapy, and chimeric antigen receptor T cell immunotherapy, have shown good therapeutic potential. By targeting specific pathways in the pathogenesis of CITP, these novel therapies aim to achieve individualized precision treatment, thereby providing patients with more effective therapeutic options. This article reviews the pathogenesis, second-line treatment approaches, and therapeutic advances in CITP.

Mandibular reconstruction refers to the restoration of the continuity of the mandible through techniques such as autologous bone grafting, thereby restoring the patient's basic appearance, reconstructing the occlusal relationship, and restoring functions such as opening the mouth, chewing, and swallowing, in order to achieve a unity of oral and maxillofacial forms and functions. Due to the fact that mastication necessitates the coordinated efforts of the masticatory muscles, mandible, dental arch, and tongue, the recovery of masticatory function not only serves as a robust indicator for the success of surgery but also enhances the patients' quality of life, facilitating an early return to normal life. Currently, for the rehabilitation of oral function in patients after mandibular reconstruction surgery, standardized tools have been established in the fields of swallowing, occlusion, and speech assessment, and targeted training has been implemented, yielding significant therapeutic outcomes. However, research related to masticatory function faces two major challenges. First, existing assessment tools primarily focus on a single dimension, such as masticatory efficiency or subjective perception, and an integrated assessment system that encompasses multiple dimensions, including bite force distribution and oral sensory perception, has not yet been established. Second, although individual studies have explored factors affecting postoperative masticatory function, a systematic consensus has not been veached, leading to a lack of precision and individualization in clinical interventions, which significantly prolongs the patients' rehabilitation period. This paper reviews the scope and limitations of existing assessment tools for masticatory function in patients after mandibular reconstruction and systematically analyzes the key factors affecting postoperative masticatory function, aiming to promote a shift in clinical practice from "structural reconstruction" to a "function-perception collaborative rehabilitation" approach, and to provide a theoretical framework for constructing evidence-based, personalized masticatory rehabilitation programs.

The patient, a 56-year-old male, was admitted to the emergency department due to confusion and elevated body temperature persisting for 1 d. He presented with multiple organ dysfunction, including coagulation dysfunction, respiratory failure, abnormal liver and kidney function, and gastrointestinal disorders. After excluding other potential causes, a diagnosis of heatstroke was made. Additionally, the patient exhibited myocardial injury and Brugada phenocopy, as evidenced by ST-segment elevation and Brugada wave on electrocardiogram. These findings may be related to several mechanisms such as myocardial thermal injury, systemic inflammatory response after heat stress, and abnormal function of temperator-sensitive ion channels. It is necessary to strengthen the understanding of heatstroke-related myocardial injury and Brugada phenotypy to help improve the treatment and prognosis of heatstroke.